The home environment and childhood obesity in low - income households : 2 Indirect effects via sleep duration and screen time

36 BACKGROUND: Childhood obesity disproportionally affects children from low-income 37 households. With the aim of informing intervention, this study examined pathways through 38 which the physical and social home environment may promote childhood overweight/obesity in 39 low-income households. 40 METHODS: Data on health behaviors and the home environment were collected at home visits 41 in low-income, urban households with either only normal weight (n=48) or predominantly 42 overweight/obese (n=55) children aged 6-13 years. Research staff conducted comprehensive, in43 person audits of the foods, media, and sports equipment in each household. Anthropometric 44 measurements were collected, and children’s physical activity was assessed through 45 accelerometry. Caregivers and children jointly reported on child sleep duration, screen time, and 46 dietary intake of foods previously implicated in childhood obesity risk. Path analysis was used to 47 test direct and indirect associations between the home environment and child weight status via 48 the health behaviors assessed. 49 RESULTS: Sleep duration was the only health behavior associated with child weight status 50 (OR=0.45, 95%CI: 0.27, 0.77), with normal weight children sleeping 33.3 minutes/day longer on 51 average than overweight/obese children. The best-fitting path model explained 26% of variance 52 in child weight status, and included paths linking chaos in the home environment, lower 53 caregiver screen time monitoring, inconsistent implementation of bedtime routines, and the 54 presence of a television in children’s bedrooms to childhood overweight/obesity through effects 55 on screen time and sleep duration. 56 CONCLUSIONS: This study adds to the existing literature by identifying aspects of the home 57 environment that influence childhood weight status via indirect effects on screen time and sleep 58 Home environment and childhood obesity 3 duration in children from low-income households. Pediatric weight management interventions 59 for low-income households may be improved by targeting aspects of the physical and social 60 home environment associated with sleep. 61 62